Spanish nurses in Germany: When mobility breeds exploitation

Opinon by Linda Mans, Wemos Foundation, co-ordinator ‘Health Workers for All’ and Sascha Marschang, policy manager for health systems, European Public Health Alliance (EPHA)

This article, contributed by Health Workers 4 All Partners Medicus Mundi (FAMME, Spain), is  the second of a series of case studies demonstrating the importance of implementing the ethical  recruitment principles of the WHO Global Code of Practice on the International Recruitment of  Health Personnel. In particular, it provides a sobering illustration of how the lure of working in a  foreign country can turn into an experience of ‘social dumping’ thanks to unscrupulous employers. 

Following the 1996-2004 reforms of the German health system, which created unfavourable working conditions in nursing and caused a reduction of personnel, at least 40,000 nurses have  left the country and the numbers of job-starters decrease. This has exaggerated existing workforce shortages at a time when the German healthcare system should prepare to meet the upcoming  needs of an ageing population. Private companies are using this as an opportunity to recruit qualified  health workers in Southern and Eastern European countries where the economic crisis is pushing  many to emigrate, especially Spain where unemployment reached record highs.

One private company claimed to facilitate “the personnel’s accreditation of the nursing qualifications  for Germany, together with economic support and subsidised accommodation”. Sounds too good to  be true? Unfortunately, that’s just what many Spanish nurses had to learn the hard way upon their  arrival in Germany.  HW4All’s case study reveals that the true conditions offered to Spanish nurses were very different  than what was promised to them during the recruitment interviews. Crucially, nurses were promised  a choice of work destinations and salaries in line with German labour law.

In reality, the nurses  were sent to rural locations and remuneration was up to 40% lower than that of their German  colleagues – as the recruiting company had not signed up to the collective agreement. Many nurses,  although university educated, were effectively doing the job of nursing assistants and had to work  excruciating 12-hour shifts without the right to even take a break. To make matters worse, they  were contractually ‘locked in’: papers had to be signed for 1.5 or 2 years, and early termination by  the Spanish nurses made them subject to very high ‘breach of contract’ fines of up to 10,000 euros.  Moreover, as a side effect of working alongside ‘cheap foreign labour’, many German colleagues felt  embittered towards the unwanted competition in an ongoing ‘race to the bottom’.

It was only after German labour union ver.di denounced the situation - and arranged a meeting  with the Berlin-based company recruiting in Spain - that the programme was closed in June 2014,  although the nurses already working in Germany remain tied to the contract. The case also created  increased collaboration between the European Federation of Public Service Unions (EPSU), ver.di and  the Spanish trade unions for health workers (FES-CCOO and FSP-UGT) to raise awareness that such  conditions are clearly unacceptable and that collective agreements must be respected.  The case also demonstrates that working conditions in the German nursing sector are often  unacceptable to German as to immigrating nurses from inside the EU. Consequently, the recruiters  look to fill the increasing numbers of vacancies from abroad: In 2013 Germany opened up the  borders for nurses from outside the EU and already signed or currently negotiates agreements with  the Philippines, Tunisia, Vietnam, China, Serbia and Moldova.

There is a lack of regulation at European level (and translation of it from EU-level to implementation  at national and local level) about migrants’ rights and the conditions to be provided by companies  (especially private intermediaries) hiring health professionals from in- and outside the EU. The  WHO Global Code specifies that there cannot be labour differences in the workforce from different  countries, and the 2013 Recife Declaration confirms this: “promote equal opportunities in education,  development, management and career advancement for all health workers, with no form of  discrimination based on gender, race, ethnicity or any other basis”.

HW4All therefore urges the EU and its Member States to make recruiters the legal duty-bearers for fully informing foreign (health)  workers about their rights.

This op-ed has been produced in the framework of the project “Health Workers for all and all for  Health Workers” DCI-NSAED/2011/106, with the financial assistance of the European Union. The  contents of this publication are the sole responsibility of the project partners and can under no  circumstances be regarded as reflecting the position of the European Union.

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